RSI affects as many as 20 million Americans and is a leading cause of work-related injury. Yet there is little research on which approaches to RSI work best. Is manifold treatment the most effective approach for positive outcomes in repetitive stress injury (RSI)?

It is widely accepted in the Western medical community that stretching, gentle exercises and relaxation are generally helpful. Relaxation may be one of the most important components not only in treatment, but also to reduce the anxiety associated with RSI and to teach the patient how to use natural body movement to deal with causes that created it.

Eastern ethnomedical methods to treat RSI are as plentiful as their Western therapy counterparts and, in both arenas, some are effective and some are not. For example, some patients claim that acupuncture does not help their RSI symptoms at all, while others do find it helpful. There is no research to support either point of view, but what works for some and not for others is not an anomaly. Let us examine what may be the ideal treatment for RSI: a manifold approach using Eastern methods that naturally complement our Western perspective of therapy.

Wrist Stretches
Wrist stretches¹ for carpal tunnel syndrome and other wrist-related RSI is a practical place to start. Western therapeutic techniques are generally not as defined as Chinese and Japanese methods when it comes to stretching the hands and wrists. Stretching is a part of what is termed in the East as "opening up the joints," which is fundamental to all Eastern therapeutic practice.

Aikido's many wrist stretches may be a bit painful at first, but with a slow and gentle application aimed at grading the intervention, these stretches should give some immediate relief to the RSI wrist patient. The therapist can demonstrate the stretches on the patients and then instruct the patient how to do these exercises routinely and daily.

What makes aikido stretches different from a general stretch for flexibility is that they should be done slowly and deliberately. This slowness is very similar to the way t'ai chi movement is performed. Relaxation coupled with stretching is helpful in reducing anxiety as well. The motion of the stretch is smooth, slow and continuous—not jerky. The rationale in Eastern ethnomedicine is to not only stretch muscles but "flexibly soften" the tendons and connective tissue and more importantly to "open up" the joint.

There are wrist stretches in performing t'ai chi movement as well. Movements such as t'ai-chi Basic's Embrace Tiger and Return to Mountain² are gentle and slow and use soft rotational motion with several repetitions to gently stretch the wrists. There are many individual t'ai-chi movements and postures the therapist may select that not only stretch the wrist but also reduce the anxiety common to patients with RSI. Chi flow may be focused at the wrists in aikido stretching and in many t'ai chi movements. This differs from acupuncture that too often focuses only on the meridians. This may explain why acupuncture is not always as effective in RSI if not used with "pin point" specificity.

Kiatsu Ryoho
Finally, in our manifold approach to RSI treatment we should consider a very direct manual therapy method, ki-pressure therapy (Kiatsu ryoho). Ki-pressure is simple and direct pressure to the affected area. These manual methods are distinguished from other Chinese and Japanese manual therapies in that the focus is on direct placing of pressure and injecting ki energy into the affected RSI area. The concentration is on promoting soft flexibility of the tendons and opening the joint for an increased rate of healing.

The fundamental core of this Eastern ethnomedicinal method is emphasized by the metaphor of priming a pump. When water does not flow up a pump, or in our case the vital physiological forces that are not functioning well, then a little water must be added to the pump to connect with the rest of the water and bring back the normalized flow.

This means that the therapist or physician with strong ki energy will be most effective. The Japanese government's Ministry of Health and Welfare recognizes ki-pressure as official, viable therapy. We should remember that what we in the West see as alternative therapy is mainstream in other cultural milieus and vice versa.

Ki-pressure may be a bit painful at first and with some patients that are hypersensitive to pain it must be begun very gently and even remotely. But, the effects of ki-pressure are felt directly after the session and more often than not, during its application.

Ki-Pressure Case Study
One case study involved a carpenter who had a classic case of RSI due to constant percussion on the carpal bones. His was not simply a matter of carpal tunnel but also tendonitis and soft tissue damage associated with years of hammering. Poor posture during work activities had also led to chronic back pain.

The carpenter was told that he would get relief from ki-pressure, wrist stretches, and the practice of t'ai chi movements, but that he would be in danger of always re-injuring his wrist as he continued to hammer at his job.

When ki-pressure was applied it was a bit painful for him. His wrists were so inflexible that he could barely bend them beyond a few degrees without pain. After one session of ki-pressure, his wrist's range of motion increased 35 degrees without pain. He was also taught general t'ai chi movement, which he practiced regularly.

The carpenter was also shown aikido wrist stretches which he practiced regularly, especially before and after hammering at his job or whenever his RSI "acted up." Over several weeks the RSI was virtually eliminated. Ki-pressure was applied only four times over that period although he took some time on numerous occasions to apply that particular ki-pressure method to himself as he was also instructed to do.

After one year, his RSI had not recurred except to a much smaller degree when hammering excessively at work. This was expected and is often the case that individuals with RSI must return to an occupation that exacerbated if not caused the condition. However, his body motion became more flexible, efficient and natural. Anxiety was also greatly reduced.

The carpenter's case demonstrates the usefulness of both a manifold approach and Eastern healing methods. There is not always an easy solution to problems that have complex causes. However, a manifold approach is prudent in RSI and will be effective not only with the wrist but also other areas of the body subject to RSI.

John and Rita Kotsias are instructors for continuing education at American Tai-Chi Tao Research and Study Center, Caledonia, MN.

References

1. Koichi, T. (1983). Ki no kenkyukai, Tokyo, Japan: H.Q. Kiatsu.

2. Kotsias, J. (1989). The essential movements of tai chi. Brookline, MA: Paradigm.

3. Kotsias, J. (1999). Tai-chi tao for physical therapists: Applications and interventions, (2nd revised ed.). Caledonia, MN: American Tai-Chi Tao.

4. Chen, Y.K. (English edition without copyright date). Tai chi ch'uan: Its effects and practical applications. Hong Kong: Sun Wah Printing Company.

5. Hain, T., Kotsias, J., & Pai, C. (2000). Alternative and complementary treatment in neuroligic illness. In M. Weintraub (Ed.). Tai Chi. New York: Churchill Livingstone.